Vendors: VA Payment to Outside Providers Increasingly Delayed

Veterans’ Credit Ratings Could Be Jeopardized

By Sandra Basu

Rep. Dan Benishek (R-MI)

Rep. Dan Benishek (R-MI)

WASHINGTON — The VA is taking too long to reimburse non-VA healthcare providers, a problem that could result in veterans being billed for the services, panelists told a House of Representatives subcommittee last month.

“The federal government has a responsibility to ensure that our veterans receive the best healthcare we can provide,” said Asbel Montes, Acadian Ambulance Service vice president of reimbursement and government affairs. “It also has a responsibility to ensure they are not required to bear an unjustified financial burden because the VA fails to pay non-VA providers in a timely and accurate manner.”

Montes and other representatives from organizations that provide services to veterans testified before a House subcommittee last month where they detailed challenges they faced when dealing with VA. These challenges included slow reimbursement, as well unaccounted for or lost medical documents that were sent to VA.

Lawmakers pressed VA officials to take responsibility during a hearing on the situation.

“The problem I have with VA is that it is never anybody’s fault,” said

, chairman of the House Committee on Veterans Affairs’ health subcommittee. “There is actually no one responsible.”Excessive claims processing times and paperwork requirements for non-VA providers are “especially acute for the majority of ambulance service providers that serve as the local 911 responders in their communities,” Montes pointed out, especially because those providers are “prohibited from refusing emergency treatment for any patient, regardless of payer source and ability to pay.”

Failure to pay these providers in a timely fashion “puts providers in the difficult position of having to bill veterans for emergency treatment,” he noted.

Montes told lawmakers that his Lafayette, LA, company and many members of the American Ambulance Association have seen a recent escalation of lack of payment from VA, with their accounts receivables due from the VA growing in excess of $30 million outstanding over 90 days.

Furthermore, he alleged that an audit done by VISN 16 showed no record of 768 claims, even though the company sent the claims to the VA through certified mail with confirmation of receipt.

“VISN 16 has sent reports to our congressional delegates with a number that would indicate improvement, but our data clearly indicates the opposite,” Montes said.

Also testifying was Vince Leist, president and CEO of North Arkansas Regional Medical Center in Harrison, AR, who testified on behalf of the American Hospital Association. He told lawmakers that the continued inability to obtain timely payment from VA and its contractors hinder access to care for veterans who need outside services from nonfederal hospitals.

“Many veterans worry about claims that are not paid promptly or are left unpaid, and they are left in a difficult position of trying to get claims paid, often while battling illness,” Leist testified. “It is an untenable position for both veterans and hospitals.”

Addressing the Problem

Gene Migliaccio, VHA deputy chief business officer for Purchased Care, told lawmakers that the VA “owns the problem of aged claims,” and is “fixing the problem.”

VA has “experienced tremendous growth in the volume of claims” provided by community providers since the implementation of the Accelerated Care Initiative which began in May of 2014, he explained.

“VHA has received 34% more claims from January 2015 through April 2015 compared to January 2014 through April 2014,” according to Migliaccio.

Steps are being taken to rectify reimbursement processing issues, including hiring more staff, he noted, adding that VA is now able to process a “clean claim,” which is one that has no defect or impropriety, within 22 days.

Some lawmakers seemed skeptical about the progress, however.

“This is not the first time that I have been at a hearing where we have several people testify about how things are from their perspective, and then we have a VA person give us a litany of all the great things that the VA is doing to improve the situation,” Benishek said.

VA officials also promised that they would provide the committee an answer to the 768 claims in question. They acknowledged there are parts of the country where the “processes aren’t, you might say, functioning seamlessly and timely.”

Meanwhile, lawmakers said that they were concerned about the impact of delayed reimbursements on veterans.

“What safeguards are in place to prevent veterans from incurring financial harm, poor credit ratings because of the delayed VA reimbursements to fee-basis care providers?” asked Rep. Raul Ruiz (D-CA).

Migliaccio responded that the VA is looking to put some systems in place so that it “doesn’t get to where the veteran is harmed.”

“We are going to focus on our people, business processes, and I want to look at technology also,” he explained.

Migliaccio further acknowledged that, while the problem for veterans exists, it is not “as severe as we think.”

Ruiz suggested that a poor credit rating due to slow VA reimbursement for even one veteran “is severe.”

“If this situation arises, we will work with the providers that send the bills to adjudicate those claims quickly,” Migliaccio responded. “We will also write letters to credit agencies to clear up credit reports.”

Comments (5)

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  1. George Woodruff says:

    This article brings to light an unforgivable problem that affects veterans who receive outside medical care with VA approval and then get billed for it because the VA delays payment for months. This happened to me when I was taken from the VA Nursing Home where I live to a local hospital’s Emergency Room for chest pain in September, 2014. The VA failed to pay in a timely manner and the hospital billed my Medicare and attempted to come after me for the balance. In the bill they sent me they stated that the care had not been approved by the VA which was a lie. As to the balance due,,,I had an AARP supplement for my Medicare so that was no problem. When I checked into it I discovered the VA had paid the entire bill in June, 2015, nearly nine months after my ER visit. The hospital has in effect double billed by getting payment from both the VA and my Medicare. As a 100 percent service disabled veteran I deeply resent both the hospital’s double billing and the VA’s failure to pay the bill in a timely manner. I have documentary evidence to prove every word in this post. FYI, I bought the AARP supplement when VA Fee Basis care some years back became so poor they would not pay physicians and I lived 118 miles from a VA Hospital. Best move I ever made..even if it did cost me money.

  2. Tim YN2(SS) USN-Rret. says:

    I am also a 100% Service connected disabled vet (due to combated related injuries). Approximately 90 days ago (March-April 2016) I was hospitalized in Central Florida (we live in Missouri) due to a heart problem (CHF). The cardiologist said I was to unstable to mo to a VA facility so I was in a private hospital the entire time.

    Now, apparently the VA has still not paid the hospital’s and Doctor’s charges and I am receiving bills saying the VA has not paid… Any suggestions?

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  4. Misty S says:

    Interesting I should come across as I receive another bill from a pre approved non VA healthcare provider. This doctor’s billing department has tried twice to get my bill paid and it was denied, yet again. This was in Jan-Feb 2016. I’m now getting threatened to send my debt to collections. So as the article stated, if such a situation arises, it will be “adjudicated quickly”. What number can I call where I can speak to an actual person and not a machine?

  5. Mary Haas says:

    Two outside providers told my husband (100% disabled) that the VA has told outside vendors they will not approve anything because they are out of money. It’s a catch 22. The VA cannot give you an appointment, but their outside vendors have been cut off. Not Good.

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